<div class="row">

    <div class="col-md-12">       

        <div class="block">
            <div class="block-title">
                <h2><strong>Formulario de Preinscripcion </strong> </h2>
            </div>
           
                <?php echo $this->Form->create('User', array('class'=>'form-horizontal form-bordered'));?>	    
                <fieldset>
                    <!--<legend><i class="fa fa-angle-right"></i> Vital Info</legend>-->
                    <div class="form-group">
                        <label class="col-md-2 control-label" for="data[User][recibo]">No. Recibo <span class="text-danger">*</span></label>
                        <div class="col-md-3">
                            <div class="input-group">

                                <input type="text"  name="data[User][recibo]" class="form-control" placeholder="Inserte el Numero de Recibo" />

                                <span class="input-group-addon"><i class="gi gi-asterisk"></i></span>
                            </div>
                        </div>

                        <label class="col-md-2 control-label" for="data[User][fecha_asignacion]">Fecha <span class="text-danger">*</span></label>
                        <div class="col-md-3">
                            <div class="input-group">
                                <input type="text"  name="data[User][fecha_asignacion]" class="form-control input-datepicker" data-date-format="yyyy-mm-dd" placeholder="mm/dd/yy" />
                                <span class="input-group-addon"><i class="hi hi-calendar"></i></span>
                            </div>
                        </div>
                    </div>

                    <div class="form-group">
                        <label class="col-md-2 control-label" for="data[User][ap_paterno]">Apellido Paterno <span class="text-danger">*</span></label>
                        <div class="col-md-3">
                            <div class="input-group">
                                <input type="text"  name="data[User][ap_paterno]" class="form-control" placeholder="Inserte el Apellido Paterno" />
                                <span class="input-group-addon"><i class="gi gi-user"></i></span>
                            </div>
                        </div>

                        <label class="col-md-2 control-label" for="data[User][ap_materno]">Apellido Materno <span class="text-danger">*</span></label>
                        <div class="col-md-3">
                            <div class="input-group">
                                <input type="text" name="data[User][ap_materno]" class="form-control" placeholder="Inserte el Apellido Materno" />
                                <span class="input-group-addon"><i class="gi gi-user"></i></span>
                            </div>
                        </div>
                    </div>

                    <div class="form-group">
                        <label class="col-md-2 control-label" for="data[User][nombres]">Nombres <span class="text-danger">*</span></label>
                        <div class="col-md-3">
                            <div class="input-group">
                                <input type="text"  name="data[User][nombres]" class="form-control" placeholder="Inserte su Nombre" />
                                <span class="input-group-addon"><i class="gi gi-user"></i></span>
                            </div>
                        </div>
                        
                        <label class="col-md-2 control-label" for="data[User][fechatitulo]">Fecha de Titulo <span class="text-danger">*</span></label>
                        <div class="col-md-3">
                            <div class="input-group">
                                <input type="text"  name="data[User][fechatitulo]" class="form-control input-datepicker" data-date-format="yyyy-mm-dd" placeholder="yyyy-mm-dd" />
                                <span class="input-group-addon"><i class="hi hi-calendar"></i></span>
                            </div>
                        </div>
                    </div>

                    <div class="form-group">
                        <label class="col-md-2 control-label" for="data[User][banco_id]">Categoria <span class="text-danger">*</span></label>
                        <div class="col-md-3">
                          <?php echo $this->Form->select('categoria_id',$dcategorias)?>
                        </div>

                        <label class="col-md-2 control-label" for="data[User][nombre_recibo]">Recibimos de: <span class="text-danger">*</span></label>
                        <div class="col-md-3">
                            <div class="input-group">
                                <input type="text"  name="data[User][nombre_recibo]" class="form-control" placeholder="Recibimos de..." />
                                <span class="input-group-addon"><i class="gi gi-money"></i></span>
                            </div>
                        </div>
                    </div>  
                    
                    <div class="form-group">
                        <label class="col-md-2 control-label" for="data[User][tipo_pago]">Tipo Pago Efectivo <span class="text-danger">*</span></label>
                        <div class="col-md-3">
                            <div class="input-group">
                                <input type="radio"  name="data[User][tipo_pago]" value="option3" /> Efectivo                                
                            </div>
                        </div>                        
                    </div>
                    
                    <div class="form-group">
                        <label class="col-md-2 control-label" for="data[User][tipo_pago]">Tipo Pago Cheque<span class="text-danger">*</span></label>
                        <div class="col-md-3">
                            <div class="input-group">
                                <div class="input-group">
                                <input type="radio"  name="data[User][tipo_pago]" value="option3" /> Cheque                                
                            </div>
                            </div>
                        </div>
                    </div>
                    
                    <div class="form-group">
                        <label class="col-md-2 control-label" for="data[User][banco_id]">Banco <span class="text-danger">*</span></label>
                        <div class="col-md-3">
                          <?php echo $this->Form->select('banco_id',$dbancos)?>
                        </div>
                    </div>
                    
                     <div class="form-group">
                        <label class="col-md-2 control-label" for="data[User][observaciones]">Observaciones <span class="text-danger">*</span></label>
                        <div class="col-md-3">
                            <div class="input-group">
                                <textarea  name="data[User][observaciones]" rows="9" cols="50" class="form-control" placeholder="Inserte alguna Observacion"></textarea>
                                <span class="input-group-addon"><i class="gi gi-folder_open"></i></span>
                            </div>
                        </div>
                    </div>

                </fieldset>

                <div class="form-group form-actions">
                    <div class="col-md-8 col-md-offset-4">
                        <button type="submit" class="btn btn-sm btn-primary"><i class="fa fa-arrow-right"></i> Guardar</button>
                        <button type="Guardar" class="btn btn-sm btn-warning"><i class="fa fa-repeat"></i> Limpiar</button>
                    </div>
                </div>
            </form>

        </div>
    </div>    
</div>